779 Endoscopic Repair of a Chronic Duodenal Perforation Complicated by a Contained Collection: A Case Report

Abstract Duodenal perforations are a surgical emergency with high mortality. Most require open or laparoscopic repair, whereby the ulcer is oversewn, sometimes using Graham patch. However, surgery not without complications. We report case of 70-year-old man chronic, perforated duodenal that was repaired endoscopically. The patient presented 1-month history epigastric abdominal pain, exacerbated by eating, and associated weight loss 3.5 stones. Examination revealed hard, irregular mass in epigastrium. CT imaging showed 6.8cm x 5.2cm 4.1cm collection an air-fluid level communicating D2 duodenum extravasation contrast into collection. unable to be drained under radiological guidance due difficulty visualising accessing it. Surgical intervention deemed difficult site chronicity perforation. underwent endoscopic repair. Two interrupted sutures were placed Apollo overstitch system. APC applied edges perforation OVESCO clip ontop. Repeat did show any evidence recurrent Endoscopic repairs have mainly been performed as adjunct repair during ERCP procedures, primarily endoclips. present where alone successful sealing whilst leaving intact. believe this interesting advances endoscopy, could provide minimal invasive option for managing perforations, especially complicated, chronic ones.